The face of the campaign against repealing the Eighth Amendment will not be a Catholic bishop. It will be a delightful smiling kid with Down syndrome. You can see her in the glossy pamphlets already delivered to homes by the apparently well-funded Love Both group. Her lovely face smiles out at us under the banner headline: “90 per cent of babies diagnosed with Down syndrome in Britain are aborted.” It is a viscerally powerful message: repealing the Eighth is the gateway to a eugenic project in which people with Down syndrome (DS) are engineered out of existence. It’s also an argument that deserves to be treated with respect. To dismiss it merely because it is uncomfortable is both wrong in itself and, for the repeal movement, potentially dangerous.
Any campaign has to be able to take on its opponents, not on their weak points, but on their strongest grounds. Those grounds have changed radically. When the Eighth Amendment was introduced in 1983, it represented things that no longer apply: the political power of the Catholic church, the attempt to stop the liberalisation of Irish social and sexual mores. So the campaign for repeal must not make the classic mistake of fighting the last war. The threat of the “screening out” of people with DS will be at the centre of the new discourse – and those who want repeal had better be ready to address it.
It is indeed true that the combination of better screening techniques and relatively free access to abortion presents the possibility of essentially eliminating DS. This is a disturbing prospect – most people with DS can live happy and fulfilled lives and their parents and siblings usually experience great joy in raising them. But it is a prospect that depends on the choices parents (and mothers in particular) will make. And those choices are nowhere near as simple as anti-abortion campaigners suggest. They argue that, if abortion is available to Irish women, they will abort babies with DS en masse. But there is very little evidence for this.
Firstly, the claim that 90 per cent of babies diagnosed with DS in Britain are aborted is not inaccurate but it is rather misleading. What it leaves out is the very large number of women – between 30 and 40 per cent – who choose not to be screened for DS because they have already decided that even if the test were positive they would continue with the pregnancy anyway. In Holland, only 35 per cent of women choose to be screened. Prof Eva Pajkrt, co-author of a Dutch study, told the Oireachtas committee on the Eighth Amendment: "We asked women their reasons. One reason was that many women in the Netherlands felt that Down syndrome was not something we should screen for. I think that reflects our way of counselling women and giving them their own choice. Our healthcare is based on patient autonomy and what women want." Choice operates both ways – some women choose abortion, some choose to raise a child with DS.
Increase in screening
Secondly, it is not true that the increase in screening has wiped out the births of DS children. In the UK, the proportion of women having a termination after a prenatal diagnosis of DS decreased from 92 per cent in 1989-2010 to the current 90 per cent. In the Netherlands, according to Prof Pajkrt, “studies have shown that the number of children born with Down syndrome has been stable. It has not decreased at all with the introduction of screening… We have about 250 born with Down syndrome annually, and the rate is a flat line.”
Thirdly, Irish women are already making these choices. The British abortion regime is, in effect, Ireland's abortion regime – and under clause E of the 1967 Abortion Act, disability is a ground for termination. Admittedly access to screening in Ireland is problematic, but even so the numbers of Irish women taking this option is strikingly small. In 2016, 3,265 Irish women had a termination of pregnancy in England and Wales. Of these 140 had a termination under clause E – and most of those were presumably not for DS.
Finally, the choice to continue with a DS pregnancy is made, not in the abstract, but in real life. Anti-abortion campaigners claim that the Eighth Amendment has made Ireland a lovely place to have a DS child. Love Both’s pamphlet says of DS that “we have a culture of equality and inclusion that we can be proud of”. Senator Rónán Mullen claims, “We have a tradition here in Ireland where children with Down syndrome are perhaps more cherished than in many other countries.” That would be the DS children who wait two years for a wheelchair or three years for language therapy. That would be Ireland whose grand total of DS clinical nurse specialists is precisely one – and she’s paid by a charity, not by the State.
We should want every woman carrying a DS child to feel that she can choose to raise that child in the knowledge that she and it will be cherished, supported and treated with dignity. Making that a reality would be much more effective than sticking to empty constitutional symbols.